Cecchini Giulio, Truong Huy Q, Di Biase Francesco, Musio Antonio, Miranda Juan C Fernandez
Department of Neurosurgery, Hospital "San Carlo" Potenza, Potenza, Italy.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Oper Neurosurg (Hagerstown). 2021 Jun 15;21(1):E15-E21. doi: 10.1093/ons/opab105.
Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important.
To describe the anatomic and technical nuances of the transposition of the temporoparietal fascial flap for lower clivus reconstruction.
A specific temporoparietal fascial flap (TPFF) design and tunneling technique has been studied using 4 head specimens, microscopic and endoscopic surgical techniques, and neuronavigation.
The L-shaped flap offers several advantages. It can be tunneled directly toward the lower clivus passing through the infratemporal fossa.
The infratemporal retro-eustachian transposition of an L-shaped TPFF provides a vascularized tissue virtually without dimension limits. This is the only technique that allows the flap to be tunneled directly in the lower clivus with the most vascular portion being at the bottom of the defect. Clinical validation is still required since more issues may become relevant in a real-surgery setting. Though, due to its possible complications, this methodology needs further testing and should not be attempted in less experienced hands.
内镜鼻内入路术后重建是关键环节。斜坡下部重建困难，多数情况下无法使用带蒂皮瓣。随着手术暴露范围的复杂性和尺寸增加，可靠的重建技术变得越来越重要。
描述用于斜坡下部重建的颞顶筋膜瓣转位的解剖学和技术细节。
使用4个头部标本、显微镜和内镜手术技术以及神经导航，研究了一种特定的颞顶筋膜瓣（TPFF）设计和隧道技术。
L形皮瓣具有多个优点。它可以通过颞下窝直接向斜坡下部构建隧道。
L形TPFF经颞下窝咽鼓管后转位可提供几乎无尺寸限制的血管化组织。这是唯一一种能让皮瓣直接在斜坡下部构建隧道且血管最丰富部分位于缺损底部的技术。由于在实际手术中可能会出现更多相关问题，仍需临床验证。不过，鉴于其可能的并发症，该方法需要进一步测试，经验不足者不应尝试。
